Breakthrough allows ‘locked-in’ patients to communicate for the first time

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Patients with ‘locked-in’ syndrome have been able to communicate for the first time, thanks to technology that interprets variations in brain activity.

The condition, which is called amyotrophic lateral sclerosis, gradually removes the ability of the brain to control muscles.

The study, published in the journal PLOS Biology, was carried out on four patients with advanced forms of the condition in Switzerland. They are completely locked in, and therefore not able to communicate by blinking, as some with ALS can.

Using an imaging technique called near-infrared spectroscopy the researchers were able to detect subtle changes in blood flow that occur depending on brain activity.

By asking yes or no questions the researchers already knew the answer to — such as the name of a patient’s spouse — they were able to develop a computer program that interprets the meaning of the answers. The system is said to be accurate 75 per cent of the time.

Professor Ujwal Chaudhary, one of the researchers, told the BBC: ‘It makes a great difference to their quality of life. Imagine if you had no means of communicating and then you could say yes or no — it makes a huge impact.’

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For patients suffering from the condition known as a complete locked-in state, communication is impossible, even to the extent of being unable to move the eyes. They remain aware but trapped in their own body, being able to think but incapable of moving or talking — a tragic situation.

This exciting new research looked at four locked-in patients, all suffering from the condition amyotrophic lateral sclerosis (ALS), where the brain is no longer able to control muscle function.

Using the technique known as near-infrared spectroscopy, scientists were able to detect changes in the colour of blood in the brain due to altered oxygen levels and asked yes-or-no questions to interpret brain signals. With an accuracy rate of around 75 per cent, this is now being used for more practical day-to-day issues such as asking if pain is present or if a family visit is wanted.

Although this is right at the cutting edge of technology, it may well mark the early steps in abolition of complete locked-in states, at least for ALS patients, which would be a remarkable step forward.RHResearch score: 4/5

When I was still young in Intensive Care, a patient’s family told me he responded to them with his eyes. His cervical spine had a high half-inch separation from a traumatic fracture. I told the family what they saw where just reflex or random movements, but went later to his bedside and asked him to open his eyes. He did. I asked him to close them. He did. I asked him to open and close them twice, etc. He did. It was one of the worst moments in my professional life – I missed unimaginable, huge, painless but huge, suffering. My first locked-in syndrome. He agreed to die in his sleep, as did all of his successors over the ensuing decades except for two whose (Middle Eastern) families kept them alive for longer.
At this moment “right at the cutting edge of technology” I wonder, gentle reader, if the recipients would not, like my patients, or Wilde’s Canterville ghost, prefer to rest in their graves. I would.